Effect of phone text message reminders on compliance with rabies post-exposure prophylaxis following dog-bites in rural Kenya

Context Prompt administration of post exposure prophylaxis (PEP) is one of the key strategies for ending human deaths from rabies. Delay in seeking first dose of rabies PEP or failure to complete the recommended PEP dosage may result in clinical rabies and death. Objectives To assess the efficacy of short message system (SMS) phone texts on adherence to scheduled PEP doses among bite patients in rural eastern Kenya. Trial design and methods We conducted a single arm before-after field trial that compared adherence among bite patients presenting at Makueni Referral Hospital in October – December 2018 (control group) and January – March 2019 (intervention group that received an SMS reminder one day prior to their scheduled PEP doses). Data on demographics, socio-economic status, circumstances surrounding the bite, expenditures related to the bite were collected for all patients. Results A total of 186 bite patients were enrolled in the study, with 82 (44%) being in the intervention and 104 (56%) in the control group. The odds of PEP completion was three times (OR 3.37, 95% CI 1.28, 10.20) among patients that received the SMS reminder compared to those that did not. The intervention group had better compliance on the scheduled doses 2 to 5 with a mean deviation of 0.18 days compared to 0.79 days for the control group ( p = 0.004). The main reasons for non-compliance included lack of funds (30%), forgetfulness (23%) on days for follow-up treatment, among others. Although the majority of bite patients (94%) were under the Makueni medical insurance cover and did not pay for PEP, nearly all (96%, n=179) the bite patients incurred indirect costs of transport at an average of 4 USD (0 - 45 USD) per visit. Conclusion This study suggests integrating SMS reminders in healthcare service delivery increases compliance to PEP and may strengthen rabies control and elimination strategies. Trial registration The study trial is registered at US National Institute of Health ([clinicalTrial.gov][1]) identifier number [NCT05350735][2]. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial The study trial is registered at US National Institute of Health (clinicalTrial.gov) identifier number [NCT05350735][2]. https://clinicaltrials.gov/ct2/show/[NCT05350735][2] ### Clinical Protocols ### Funding Statement ST and KH had funding support from the Wellcome Trust (Grant numbers 110330/Z/15/Z and 207569/Z/17/Z respectively). This study was partly funded through a grant from Sanofi to Kenyan Medical Research Institute. VMC was partly supported by the Fogarty International Center and the Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number D43TW011519. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Kenya Medical Research Institute/Scientific and Ethics Review Unit (SERU) (Ref No. KEMRI/SERU/CGHR/046/3268) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The dataset generated and analyzed for this study is available from Open Science Framework: https://osf.io/zxeqr/. This dataset is available under a CC0 1.0 Universal license and DOI - DOI 10.17605/OSF.IO/ZXEQR [1]: http://clinicalTrial.gov [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05350735&atom=%2Fmedrxiv%2Fearly%2F2022%2F06%2F17%2F2022.06.16.22276500.atom